Veterans Affairs committee  I certainly don't know about that. I don't know if anybody else does.

Veterans Affairs committee  Certainly anti-malarials have been provided for a fairly significant period of time, certainly predating mefloquine. We can't really speak to given missions at this point, but we do know that doxycycline had been used, and chloroquine was used in certain areas where the malaria is not resistant to chloroquine.

Veterans Affairs committee  I'll ask Colonel Jetly to speak to that. He is quite engaged with the international community.

Veterans Affairs committee  Things have changed over time. I can tell you how things work right now with prescriptions provided on base. We have a system that, whether a prescription to a military member is obtained in a civilian pharmacy or on base, it is entered into the same system, as long as the individual uses his or her Blue Cross card when they go to a civilian pharmacy.

Veterans Affairs committee  That's a challenge. Trying to attribute an outcome to an incident or to a medication can be very difficult. When one looks at anecdotes, at single cases or groups of single cases, one might easily overlook other factors that might be at play. When we were speaking a bit earlier—and there's no evidence for this—what role did heat have to play in this?

Veterans Affairs committee  I suppose it depends on when and where the mission was.

Veterans Affairs committee  Somalia: I was a student in those days and not working in the system at that time, so I don't know exactly what took place. From what I have read, screenings weren't done in that sense. There wasn't a check, a questionnaire that was filled out by serving members, but the expectation would have been that people would have had their medical file annotated or the pharmacy record on them would have been kept.

Veterans Affairs committee  That report is from a number of years ago. It was ordered by my predecessor. Although I've read the report a number of times, I don't remember the specific numbers and what it said. I do know that when we looked at it, we found there were a number of people who were prescribed mefloquine when there were existing contraindications to doing that.

Veterans Affairs committee  I'd like to respond to a number of different elements. The first one is that quinism is not a recognized diagnosis. It doesn't exist in the manual of diagnoses that we use when we're coding things. It is also a hypothesis, and Dr. Nevin refers to it himself as a hypothesis. A hypothesis is an idea that is not fully supported by research.

Veterans Affairs committee  I would say that humans all have bias. On the issue of confirmation bias, I'm not quite sure what you're referring to there. I presume you're referring to the fact that we have a hypothesis on the table and that people are looking to confirm their hypothesis. Is that what you're referring to?

Veterans Affairs committee  I can't really answer that question. It's quite possible that this is the case. I think when you look at all the studies that are being done and reports that are being generated, there are biases, a number of different kinds of biases. I do think there is a desire among some to prove a theory, prove a hypothesis, but the real evidence for it is not strong.

Veterans Affairs committee  I don't think those questions really confirm anything. One of the problems is recall bias as well. We know that people often confound the different medications that they've been given, and sometimes that's one of the criticisms of surveys that are conducted after the fact. However, asking people questions gives you perhaps a sense of what the issue might be, but what we lack is a definitive test whereby we can confirm whether that is the case.

Veterans Affairs committee  Perhaps I'll ask Dr. Jetly to answer that question.

Veterans Affairs committee  Thank you. I'll start by trying to provide an answer to the question prior to passing it on to my colleagues. One of the purposes of doing screening is to be able to do something about it. The current situation is that, although we could ask questions about what people did or did not take, as far as the understanding or the science around actually conducting a test is concerned, there is no specific test to be conducted.

Veterans Affairs committee  Good afternoon, Mr. Chair and members of the Standing Committee on Veterans Affairs. Thank you for the opportunity to discuss the use of mefloquine as a medication to prevent malaria in the Canadian Armed Forces. As you know, malaria is one of the world's most significant infectious diseases.